Distressed, Disruptive and “Unmotivated” Clients: What to do when they walk through your door Presented by Dr. Debbie Samsom, Registered Psychologist November, 2013

Back in Motion Rehab Inc. Distressed Clients: Do they have a mental health diagnosis?  Symptoms of MH disabilities are multiple and varied depending on the diagnosis  Focus on observations Crying spells Irritability Limited interpersonal skills Agitation Withdrawal from others Poor/inconsistent follow through Poor personal grooming Lack of participation in daily activities  Ask the Client about what you observe

Back in Motion Rehab Inc. Employment Planning Principles  Strengths  Vocational Interests  Limitations/Barriers – strategies to address  Workplace Supports and Accommodations *Level of employability is linked to what you discover here (not to a specific diagnosis)

Back in Motion Rehab Inc. Where do we get information?  Historical Information Available  New Information Gathered Community Agencies Family Members Referral for assessments (Medical, Vocational- Psychological, Work Simulation Assessment)  The Client

Back in Motion Rehab Inc. The Client as a Source of Information  Don’t be afraid to ask  Insight (individual and diagnosis dependent)  Duration of Mental Health Diagnosis  Desire to Disclose

Back in Motion Rehab Inc. Distressed Clients - Strategies  Talk about the behaviours you see (or don’t see)  Problem-solve with Client (What will help?) Medication review Increased self-care Change of schedule Disability Management workshop participation Referral to community services Program interrupt (with plan)

Disruptive/Demanding Clients - Examples  “People who project a negative and rude attitude.”  “Within a workshop, Clients who are demanding and won’t let others talk”  “Lack of self-control – being emotionally charged easily when not getting “yes” for answers” Back in Motion Rehab Inc.

Disruptive/Demanding Clients - Strategies  Be calm, empathic and respectful  Have “difficult” conversations (tell the truth)  Set boundaries and expectations  People with mental health issues don’t want or need a “pass”  Never say you’re too busy or don’t have time  Document ethically and effectively  Learn de-escalation skills

Back in Motion Rehab Inc. Unmotivated Clients - Examples  Mental health clients who won’t access the help they require  Clients who don’t follow instructions  Clients who avoid contacting employers for informational interviews  Clients who are “lethargic” about their job search In other words, Clients who won’t do something that we think they should do.

Motivational Interviewing References: O’Connell, D. (2013). Helping Clients to Change Behavior, presented at the 9 th Annual Health Care Professional Conference. Vancouver BC. Miller, W & Rollnick, S. (2012). Motivational Interviewing, 3 rd Edition: Helping People Change. New York: Guilford Press. Motivational Interviewing References: O’Connell, D. (2013). Helping Clients to Change Behavior, presented at the 9 th Annual Health Care Professional Conference. Vancouver BC. Miller, W & Rollnick, S. (2012). Motivational Interviewing, 3 rd Edition: Helping People Change. New York: Guilford Press.

Back in Motion Rehab Inc. What is MI? MI is a collaborative goal-oriented style of communication, with particular attention to the language of change. MI is designed to strengthen personal commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.

Back in Motion Rehab Inc. Elements of MI?  Focus is on your interaction with client  Communication style is one of guiding (rather than directing or following)  Collaboration (done with)

Back in Motion Rehab Inc. Motivational Strategies: The Building Blocks  Providing information  Removing practical barriers  Providing Choice  Identifying the benefits of change  Practicing empathy  Providing feedback  Clarifying goals  Active helping

Back in Motion Rehab Inc. 4 Processes of MI 1.Engaging: establishing a working relationship 2.Focusing: establishing an agenda 3.Evoking: eliciting client’s own motivation to change 4.Planning: committing to a specific course of action

Back in Motion Rehab Inc. Ambivalence is Normal  Explore ambivalence, rather than think resistance  Develop a discrepancy between present behaviour and goals and values  When a behaviour is seen as conflicting with goals, change is more likely to occur  Client rather than the practitioner should present the argument for change

Back in Motion Rehab Inc. Ambivalence is Normal  The Client is not an opponent  It’s not about winning and losing  It’s not about convincing  It’s not about telling someone what to do  If asked for advise, give a set of options  Remind yourself and the Client of their autonomy *The Client is the primary resource for finding answers and solutions

Back in Motion Rehab Inc. Change Talk vs. Sustain Talk  Change talk are statements that indicate some movement in the direction of change “I need to do something about this” “I suppose I could at least update my resume”  Sustain talk are statements that indicate support for the status quo “I don’t think I’m ready to get a job” “I don’t see how that would help”

Back in Motion Rehab Inc. Don’t Encourage Sustain Talk  Questions that elicit sustain talk What gets in the way of …? What prevents you from …? Why haven’t you …?  Even empathic statements can encourage sustain talk so watch how you use them

Back in Motion Rehab Inc. Evoking Change Talk  Desire (I wish, I want, Wouldn’t it be great if)  Ability (I could, I would be able to, I have done that in the past)  Reasons (I would have more money, I would have something to talk about, I wouldn’t be bored)  Need (Must, should, ought to, have to)

Back in Motion Rehab Inc. Ready to Start Planning  Look for signs of readiness Increased change talk Diminished sustain talk Increased resolve Envisioning  Transition from Evoking to Planning So where does all of this leave you? What do you think you might do?

Back in Motion Rehab Inc. Checking For and Strengthening Commitment  Commitment – Is that what you intend to do? So, in order to get this going, what would you have to do first?  Activating – How would you get ready? Are you willing to give that a try?  Taking Action – So you checked out that website I sent you. I see that you are looking over the workshops we offer.

Back in Motion Rehab Inc. Motivational Interviewing  Empowers people to make positive changes  Fosters pleasant relationships with our Clients  Makes our job easier! Thank you